Buckeye Lake, OH · Licking County
Authorization Agreement for Direct Payments (ACH Debits) of Water Bills
This agreement lets a Buckeye Lake water customer authorize the Water Department to debit a checking or savings account for water bills.
What this form is
Use this agreement to authorize the Buckeye Lake Village Water Department to initiate ACH debit entries for water bills from a checking or savings account. It asks for the depository bank name, routing and account numbers, water service address, water account number, date, and signature. Attach a voided check for a checking account or a deposit slip for a savings account.
Who needs it
A water customer who wants to authorize direct ACH debits from a checking or savings account for water bills needs this agreement.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This agreement is signed and dated without a notary; attach a voided check for checking or a deposit slip for savings, and the signer just signs and dates it.
How to submit this form
- 1
Download The Agreement
Download the Water Bill ACH Direct Payment Authorization PDF.
- 2
Complete The Agreement
Select checking or savings and provide the bank, account, water service, and customer information requested.
- 3
Gather The Attachment
Attach a voided check for checking or a deposit slip for savings.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the water bill ACH authorization?
- No. The agreement has a signature and date line, not a notary block. Attach a voided check for checking or a deposit slip for savings.
- How do I submit the ACH authorization?
- Submit it to the city department named on the form; check the city website for current contact details.
- What account information does the agreement request?
- It asks for the depository bank name, routing number, account number, and whether the account is checking or savings, along with water service and customer details.
- What attachment should I include?
- The form says to attach a voided check for a checking account or a deposit slip for a savings account used for ACH debit transactions.